University Hospital, Strasbourg cedex, France.
Lung Cancer. 2011 Dec;74(3):364-8. doi: 10.1016/j.lungcan.2011.06.006. Epub 2011 Sep 3.
Because of increasing life expectancy and of higher risk of cancer with ageing, lung cancer in elderly is a frequent disease. For a long time nihilism influenced treatment decisions in elderly patients with advanced non-small cell lung cancer. Since the beginning of the last decade single agent chemotherapy has been accepted as standard of care, vinorelbine and gemcitabine being the most frequently used drugs in Europe and US, docetaxel in Japan. Platinum-based doublets have been shown to be superior to monotherapy in young and fit patients with advanced non-small cell lung cancer. Although there were some indications from subgroup analyses of clinical trials not specifically dedicated to elderly patients that a platinum-based doublet might also benefit to older patients, there was no definitive proof of concept until ASCO meeting 2010. At this meeting results of a phase 3 trial showed that PS 0-2 patients, aged 70-89 years drove a significant benefit from a treatment with carboplatin associated to weekly paclitaxel compared to a monotherapy. Thus, the paradigm of treatment in elderly patients should perhaps be modified from a single agent to doublet chemotherapy. Whether other platinum-based doublets would provide the same benefit as the specific one studied remains to be evaluated.
由于预期寿命的延长和衰老导致癌症风险的增加，老年肺癌是一种常见疾病。长期以来，虚无主义影响了老年晚期非小细胞肺癌患者的治疗决策。自上一个十年初以来，单药化疗已被接受为标准治疗，长春瑞滨和吉西他滨是欧洲和美国最常用的药物，多西他赛在日本。与单药治疗相比，含铂的双药联合化疗已被证明在年轻且身体状况良好的晚期非小细胞肺癌患者中更具优势。尽管临床试验的亚组分析有一些迹象表明，含铂的双药联合化疗可能也有益于老年患者，但直到 2010 年 ASCO 会议才提供了明确的概念证明。在这次会议上，一项 3 期试验的结果表明，PS 0-2 患者，年龄 70-89 岁，与单药治疗相比，接受卡铂联合每周紫杉醇治疗有显著获益。因此，老年患者的治疗模式可能需要从单药治疗改为双药化疗。其他含铂的双药联合化疗是否能提供与所研究的特定药物相同的获益仍有待评估。
